Overview The appendix is a normal true diverticulum of the caecum that is prone to acute and chronic inflammation. Acute appendicitis is the most common surgical emergency. Lifetime risk: 1 in 15 people. Can occur at any age but peak 10 – 30 years. Slightly more common in males. Acute appendicitis is rare before age 2 as the appendix is cone shaped with a larger lumen.
Definition Appendix Appendicitis: Inflammation of the appendix Uncomplicated appendicitis: Acutely inflamed, phlegmonous, suppurative, or mildly inflamed appendix with or without peritonitis Complicated appendicitis: Includes gangernous appendicitis, perforated appendicitis, localised purulent collection at operation, generalised peritonitis and periappendiceal abscess Appendectomy (appendicetomy): Surgical removal of the appendix. A standard treatment for appendicitis. A ruptured appendix is considered a medical emergency. Appendicetomy can be either done open or laproscopic. |
Clinical Presentation Classically periumbilical pain that moves to the right iliac fossa. Anorexia is an important feature; vomiting is rarely prominent – pain normally precedes vomiting in the surgical abdomen. Constipation is usual. Diarrhoea may occur.
Examination 3 classic maneuvers:
Differential Diagnosis based on age
Remember For female patients rule out ectopic pregnancy and ectopic rupture. |
Remember Acute Appendicitis is a clinical diagnosis and is addressed surgically. When there is a high degree of clinical suspicion, an appendicectomy can be performed without imaging |
Diagnosis Armando score (TRAMLINE)
Remember Acute appendicitis is essentially a clinical diagnosis |
Prompt Appendicectomy. Laparoscopy has diagnostic and therapeutic advantages. It is not recommended in cases of suspected gangrenous perforation as the rate of abscess formation may be higher.
DIFFERENCE BETWEEN LAPAROTOMY AND LAPROSCOPY | ||
Laproscopy | Open | |
Indications | Routine appendicitis Obese patients Elderly patients Uncertain diagnosis |
Pregnancy women Small children When Laproscopy is not available |
Benefits | Earlier resumption of liquid and solid intake ↓Duration of postoperative hospital stay ↓Postoperaitve pain and better cosmetic result ↓Overall complication rate including postoperative ileus ↓Incidence of wound infections ↑Diagnostic accuracy |
↓Incidence of intra-abdominal abscess formation ↓Incidence of intraoperative complications ↓Operative time ↓Operative and Inhospital Costs |
Risks | Adhesions | Predisposing to a future right sided direct hernia |
Post-Operative
Complications
Prognosis
Most frequently found incidentally found in the appendix postappendicectomy. Comprise 85% of all appendiceal tumours. If <1cm in diameter, it is considered cured by appendicectomy. If >2cm in diameter (rare), investigate for spread to sentinel lymph nodes. Managed by hemicolectomy.